肾移植术后人巨细胞病毒感染的早期诊断和抢先治疗效果

Early diagnosis and preemptive therapy of human cytomegalovirus infection in renal transplant recipients

目的 评估肾移植术后人巨细胞病毒（HCMV）感染的早期诊断和抢先治疗效果.方法 选择2007年1月至2009年1月进行肾移植手术并坚持随访的165例受者作为研究对象.移植术前及术后第2～8周每周1次、第9～24周每2周1次收集受者血液和尿液标本.采用实时荧光定量聚合酶链反应（FQ-PCR）方法检测血液和尿液标本中的HCMV DNA拷贝数.对浓缩尿中HCMV DNA超过103拷贝/ml的受者,立即给予更昔洛韦进行抢先治疗.结果 165例肾移植受者术前血液和浓缩尿中均未检测到HCMV DNA;从术后第2周开始,浓缩尿中就可检测到HCMVDNA,峰值出现在第6～8周,且同一检测时间点,浓缩尿中HCMV DNA阳性例数均明显多于血液中阳性例数.术后共有30例受者血液中检测到HCMV DNA,阳性率为18.18%;有64例受者浓缩尿中检测到HCMV DNA,阳性率为38.79%;浓缩尿中阳性率明显高于血液,差异有统计学意义（P＜0.05）.血液和浓缩尿中HCMVDNA均阳性的30例受者,经更昔洛韦抢先治疗后,病毒拷贝数逐渐下降,但有8例发展为巨细胞病毒性肺炎,经加强抗病毒以及其他综合治疗后痊愈,浓缩尿中HCMVDNA转阴时间为（10.2±3.4）d.另34例仅浓缩尿中HCMV DNA阳性的受者,经更昔洛韦抢先治疗后,无一例发展为巨细胞病毒性肺炎,浓缩尿中HCMV DNA转阴时间为（5.5±2.1）d,与血液和浓缩尿中HCMVDNA均阳性的受者比较,其转阴时间明显缩短,差异有统计学意义（P＜0.05）.结论 采用FQ-PCR方法检测受者的浓缩尿能提前检出HCMV DNA,提高阳性检出率.一旦受者浓缩尿中HCMV DNA阳性,采用抢先治疗效果较好.

Objective To evaluate early diagnosis and preemptive therapy of human cytomegalovirus infection in renal transplant recipients. Methods We selected 165 renal transplant recipients who underwent transplantation from January 2007 to January 2009 and adhered to follow-up as research subjects. The samples of blood and urine were collected before transplantation, every 1 week from 2 to 8 weeks and every 2 weeks from 9 to 24 weeks after transplantation. The viral load of blood and urine was detected by fluorescence quantitative polymerase chain reaction （FQ-PCR）. Once HCMV DNA load was more than 103 copies/ml, preemptive therapy was done immediately by ganciclovir. Results All the samples of blood and urine were negative before operation. HCMV DNA load could be detected in the concentrated urine at the second week and the peak of HCMV DNA loadoccurred from the sixth to eighth week after operation. At the same detection time, the number ofpositive recipients in the concentrated urine was more than in blood. In 30 cases HCMV DNA load was detected in the blood and the positive rate was 18.18%. In 64 cases HCMV DNA load was detected in the concentrated urine and the positive rate was 38.79%. The positive rate of the concentrated urine was significantly higher than in blood （P＜0.05）. In 30 cases positive for HCMV DNA in the blood and urine, ganciclovir was given and the viral load was decreased gradually. But 8 recipients developed into CMV pneumonia and were cured through the comprehensive treatment. The clearance time of HCMV DNA in the concentrated urine was 10.2 ± 3.4 days. Thirty-four cases that were only positive for HCMV DNA in the urine were also treated by ganciclovir and no case developed into CMV pneumonia. The clearance time of HCMV DNA was 5.5 ± 2.1 days, and the clearance time was shortened as compared with that in those positive for HCMV DNA in the blood and urine （P＜0.05）. Conclusion FQ-PCR can detect HCMV DNA in the concentrated urine in advance and increase the positive rate. Once the sample of the concentrated urine is positive, preemptive therapy has a good effect.